Henrietta Lacks replaces Robt E Lee

https://mastodon.social/@Sheril/109551240176991160

Anthony Fauci: A Message to the Next Generation of Scientists

… At ‌81, I still can clearly recall the first time I drove onto the bucolic N.I.H. campus in Bethesda, M‌‌d., in June of 1968 as a 27-year-old newly minted physician who had just completed residency training in ‌New York City. My motivation and consuming passion at the time were to become the most highly skilled physician I could‌‌, devoted to delivering the best possible care to ‌my patients. ‌This remains integral to my ‌‌identity, but I did not realize ‌‌how unexpected circumstances would profoundly influence the direction of my career and my life. I would soon learn to expect the unexpected.

I share my story, one of love of science and discovery, in hopes of inspiring the next generation to enter health-related careers — and to stay the course, regardless of challenges and surprises that might arise…

https://www.nytimes.com/2022/12/10/opinion/anthony-fauci-retirement.html?smid=nytcore-ios-share&referringSource=articleShare
Anthony Fauci: A Message to the Next Generation of Scientists

We Can Cure Disease by Editing a Person’s DNA. Why Aren’t We?

But for the next few years, devastating genetic ailments and cancer are where CRISPR clinical trials must remain; ethical considerations over the safety of patients being exposed to new technology dictate that. Today's tools are also the cognate of the first iPod — at the time, an exhilarating advance but still low tech compared with present-day smartphones. Everything we learn about how to gene-edit people from this work, coupled with continued CRISPR innovation in the academic and for-profit sector, will provide a foundation for more deeply understanding how to safely edit DNA to treat and potentially prevent dire common diseases.

The invention of CRISPR gene editing gave us remarkable treatment powers, yet no one should do a victory lap. Scientists can rewrite a person's DNA on demand. But now what? Unless things change dramatically, the millions of people CRISPR could save will never benefit from it. We must, and we can, build a world with CRISPR for all.

https://www.nytimes.com/2022/12/09/opinion/crispr-gene-editing-cures.html?smid=nytcore-ios-share&referringSource=articleShare
We Can Cure Disease by Editing a Person's DNA. Why Aren't We?

Prognosis

https://www.instagram.com/p/CktxD7xh5ws/?igshid=MDJmNzVkMjY=

Much Work Remains

	Johns Hopkins Berman Institute of Bioethics ⁦‪@bermaninstitute‬⁩ We Advised Biden on the Pandemic. Much Work Remains to Face the Next Crisis. By Ezekiel J. Emanuel, David Michaels, Rick Bright and Michael T. Osterholm nytimes.com/2022/10/19/opi…   10/21/22, 2:31 PM

The neglected clitoris

Half the World Has a Clitoris. Why Don't Doctors Study It?
https://www.nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html?smid=nytcore-ios-share&referringSource=articleShare

America Is Choosing to Stay Vulnerable to Pandemics - The Atlantic

Recently, after a week in which 2,789 Americans died of COVID-19, President Joe Biden proclaimed that "the pandemic is over." Anthony Fauci described the controversy around the proclamation as a matter of "semantics," but the facts we are living with can speak for themselves. COVID still killsroughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic "over" is like calling a fight "finished" because your opponent is punching you in the ribs instead of the face...

https://www.theatlantic.com/health/archive/2022/09/covid-pandemic-exposes-americas-failing-systems-future-epidemics/671608/

Scientists Knew More About Covid-19 Than We Think. And They Still Do.

"Nobody," Donald Trump claimed in a March 2020 address, "had any idea." He was talking about the Covid virus — which had, seemingly overnight, sparked a global pandemic. In his compelling and terrifying new book, "Breathless: The Scientific Race to Defeat a Deadly Virus," the veteran science journalist David Quammen demonstrates just how much was known — and expected — by infectious disease scientists long before patrons of the Huanan Seafood Wholesale Market fell ill in December 2019 with a pneumonia-like virus.

"Soothsayer" isn't on Quammen's extensive résumé, but he was among those who had long predicted this kind of catastrophe. In 2012 he provided a field guide to the future, "Spillover," whose subtitle — "Animal Infections and the Next Human Pandemic" — explains exactly what the scientific community had long been expecting.

"This is a book about the science of SARS-CoV-2," he specifies in his new book. "The medical crisis of Covid-19, the heroism of health care workers and other people performing essential services, the unjustly distributed human suffering, and the egregious political malfeasance that made it all worse — those are topics for other books." Instead, he focuses his informed attention on the unsung heroes who dare to wrestle with viruses, those strange entities he calls "the dark angels of evolution." Human beings are part of a sprawling family of interconnected species who can share illness because they all grew up together. It is our common ancestry and related bodily ecology that makes spillover possible between, say, bats and Earth's (currently) dominant mammal.

Covid is, after all, as natural as a wolf cub or David Attenborough, and its thriller-level rate of evolution is part of its danger. "A virus is a parasite, yes," writes Quammen, "a genetic parasite, to be more precise, using the resources of other organisms to replicate its own genome." He demonstrates the sheer weirdness of viruses when he explains how difficult it is to even define them...

https://www.nytimes.com/2022/10/01/books/review/breathless-david-quammen.html?smid=nytcore-ios-share&referringSource=articleShare

Tweet by NPR on Twitter

	NPR ⁦‪@NPR‬⁩ Researchers say diseases that spread between humans and animals, like COVID and monkeypox, will become increasingly commonplace as human expansion into previously uninhabited areas intensify. n.pr/3SlA8xG   9/29/22, 6:06 AM

‘Very Harmful’ Lack of Data Blunts U.S. Response to Outbreaks

'Very Harmful' Lack of Data Blunts U.S. Response to Outbreaks

Major data gaps, the result of decades of underinvestment in public health, have undercut the government response to the coronavirus and now to monkeypox.

https://www.nytimes.com/2022/09/20/us/politics/covid-data-outbreaks.html?smid=nytcore-ios-share&referringSource=articleShare

Her Discovery Changed the World. How Does She Think We Should Use It?

…What about the ethics of all those gene-editing possibilities? That's something you've been talking about for years now, but what would it look like to actually resolve those ethical issues? What is the green light we'd be waiting for that would make us say, "This form of gene editing was not OK yesterday, but it is OK today?" Maybe let's start with, "Where are the ethical boundaries right now for CRISPR technology?" Two come to mind…

3

 But at the same time it could clearly have environmental impacts that might be of concern. That's one aspect. The other is using CRISPR in the human germ line. Meaning making changes in embryos that, if implanted to create a pregnancy, then would create human beings who have edits to their DNA that are not just affecting them but can also be passed on to future generations. Those are two distinct applications, but it's fairly clear why both of those could have profound impacts that could be dangerous. Understanding that, and then thinking about how to proceed as the technology continues to advance, has been incredibly important. Let's take the human-embryo example. Is there a particular event or decision or developments that would suddenly make us say, "Oh, we didn't think it was OK yesterday, but now it seems fine?" No. But it's a complex issue. There would be technical considerations. In other words, even before we ask, "Should we do this?" we have to ask, "Can it be done accurately and safely in a way that creates a change that is desired by the scientist who's doing the work?" Right now that's still not true in human embryos, I would say.

https://www.nytimes.com/interactive/2022/08/15/magazine/jennifer-doudna-crispr-interview.html?smid=nytcore-ios-share&referringSource=articleShare

A huge side benefit of the new climate bill

Air pollution sickens and kills millions every year. Here’s how the new measure will help tackle the problem.

...the law will avert heart attacks, lower emergency room visits of people suffering from respiratory problems and reduce hospital admissions by people with cardiovascular disease...
https://www.nytimes.com/2022/08/12/climate/climate-air-pollution-health.html?smid=em-share

Why Storytelling Is Part of Being a Good Doctor

Doctors are people too.

"…the word 'doctor' comes from the Latin 'to teach.' By writing stories, we as doctors aim to teach others about our patients while learning about ourselves."

https://www.newyorker.com/magazine/2022/07/25/why-storytelling-is-part-of-being-a-good-doctor-all-that-moves-us-jay-wellons

Time for a national public health system

Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs major improvements. Now, a blue-ribbon commission assembled by the Commonwealth Fund has issued a reportwith a rather provocative conclusion: The United States needs a Since the early months of the covid-19 pandemic, it's been clear that the U.S. public health system needs a national public health system.... Leana Wen

https://www.washingtonpost.com/opinions/2022/07/05/is-it-time-national-public-health-system/

BCSP/HT Change Your Mind

Berkeley Center for the Science of Psychedelics 

Friends, readers, viewers, 

I’m happy to share that the four-part Netflix series based on How to Change Your Mind is streaming beginning today. 

I’m grateful to the whole crew at Jigsaw Productions for their brilliant work in bringing the book to the screen. You can read a review of the series here.

I’m also pleased to announce the launch, today, of a new psychedelic resources website from the Berkeley Center for the Science of Psychedelic (BCSP). The inspiration for the website was our concern that the Netflix series would create a wave of interest and curiosity about psychedelic therapy. We decided that it would be helpful if these viewers had a one-stop site that could answer their questions—including descriptions of the various substances; their risks and benefits; advice for people seeking psychedelic therapy, and much more, all written and edited by a team of journalists.

Thanks to the crew at the BCSP, as well as the teams at Pentagram and Wordpress, for the inspired work that went into building the site. 

I hope you’ll get a chance to explore the site as well as watch the series. Do let me know what you think!

Best,

Michael Pollan

 

CRISPR cure for sickle cell nearly 100% effective after three years

Newly released data shows nearly universal efficacy with no drop in effectiveness.

By B. David Zarley

June 25, 2022

When CRISPR Therapeutics and Vertex used gene editing to try to cure heritable blood disorders in 2019, it marked the first CRISPR trial outside of China.

A year later, the trial — using the CRISPR gene editor to treat sickle cell disease and beta thalassemia — showed promising results, Freethink reported in 2020. 

Now, three years after the trial began, the researchers have presented new data showing that the treatment continues to be effective. 

“These data provide further evidence that this treatment has the potential to be transformational for patients with sickle cell disease and beta thalassemia,” trial abstract author Stephan A. Grupp of the Children’s Hospital of Philadelphia said in a statement. 

New data shows that the CRIPR sickle cell and beta thalassemia treatment continues to be effective even three years out.

The diseases: Severe sickle cell disease (SCD) and transfusion-dependent beta thalassemia (TDT) are both caused by genetic mutations impacting hemoglobin, the molecule red blood cells use to carry oxygen throughout the body. 

In SCD, atypical hemoglobin causes the red blood cells to twist out of shape, contorting into crescents — or sickles — that cannot deliver oxygen as well. The disease can cause tiredness and shortness of breath, and periodic sickle cell crises cause intense pain.

 

In TDT, patients do not produce enough hemoglobin at all, sometimes requiring repeated blood transfusions, which have their own risks and side effects.

Both can be treated by a stem cell transplant from a suitable donor, which not only requires finding a good match but may also require suppressing the patient’s immune system.

The therapy: The CRISPR treatment, originally dubbed CTX001 and now called exa-cel, is a one-time treatment that genetically alters the patient’s own cells to produce the kind of hemoglobin found at birth, which isn’t distorted, allowing red blood cells to work properly.

The new data, presented at the European Hematology Association Congress but yet to be published in a peer-reviewed journal, reported results from 75 patients. 

Of the TDT patients, 42 out of 44 were blood transfusion-free up to 37.2 months after their exa-cel infusion, according to CRISPR Therapeutics and Vertex. They are essentially cured of the disease. 

The CRISPR therapy is a one-time treatment that genetically alters the patient’s own cells.

The remaining two patients needed much less transfusion volume, and all of the TDT patients had elevated levels of fetal hemoglobin and total hemoglobin in their blood.

All of the SCD patients were free from sickle cell attacks, up to 32.3 months later.

Two of the TDT patients suffered adverse effects possibly related to exa-cel, including delayed growth of white blood cells and a low blood platelet count, both of which resolved on their own.

Importantly, the team found no evidence of exa-cel’s effectiveness waning over time, even three years after infusion. 

“Although we must continue to investigate the durability of these results, I am excited about the current data,” Grupp said.

 

Authors Michael Lewis and Malcolm Gladwell | C-SPAN.org

Michael Lewis on The Premonition—
https://www.c-span.org/video/?518489-2/authors-michael-lewis-malcolm-gladwell

Australia’s solution

	CBS Sunday Morning 🌞 ⁦‪@CBSSunday‬⁩ In Australia, there have been only one mass shooting, and gun homicides decreased nearly 60%. After 35 people were killed in a mass shooting in Port Arthur, Tasmania, in 1996. The government of Australia enacted strict gun control legislation cbsn.ws/3x27GHM pic.twitter.com/S2JqpwmNdy   5/29/22, 9:07 AM

Sandy Hook to Uvalde

	CBS Sunday Morning 🌞 ⁦‪@CBSSunday‬⁩ Francine and David Wheeler, whose son Ben was among the 26 students, teachers and staff killed in the 2012 Sandy Hook Elementary School shooting in Newtown, Conn., are one of nine families who accomplished the unthinkable: they sued Remington Arms cbsn.ws/3lU9pJV   5/29/22, 8:27 AM

The Anti-Vaccine Movement’s New Frontier

A wave of parents has been radicalized by Covid-era misinformation to reject ordinary childhood immunizations — with potentially lethal consequences.

https://www.nytimes.com/2022/05/25/magazine/anti-vaccine-movement.html?referringSource=articleShare

Anti-vax, an old story

	The Skeptics' Guide To The Universe ⁦‪@SkepticsGuide‬⁩ Anti-vaccine propaganda is nothing new. This cartoon is a response to the use of cowpox to inoculate against smallpox over 200 years ago. Somehow their tactics have gotten both better and worse since then… pic.twitter.com/2RNNlbaCtJ   5/29/22, 10:30 AM

 

How Public Health Failed America

The U.S. clearly failed to heed expert advice, but there’s plenty of blame to go around.

By Jay Varma

MAY 15, 2022, 7 AM ET

https://www.theatlantic.com/ideas/archive/2022/05/how-public-health-failed-america/629869/

About the author: Jay Varma, a professor at Weill Cornell Medical School, is a physician and epidemiologist who worked for the CDC in New York, Bangkok, Beijing, and Addis Ababa.

Even though anthony Fauci, the White House’s chief medical adviser, backed off his statement that the United States is “out of the pandemic phase,” elected officials and much of the public seem to think that he had it right the first time. But if the end of the COVID-19 emergency is at hand, the United States is reaching it with lower vaccination and higher per capita death rates than other wealthy nations. The conventional wisdom is that the American political system failed at public health—by prioritizing individual rights over collective safety; sowing doubt about the benefits of vaccines, masks, and other protective measures; and most important, failing to implement universal health care, paid sick leave, and other safety-net programs.

I agree with the conventional wisdom. But there’s plenty of blame to go around. Public health also failed America. The two most important federal public-health agencies, the CDC and the FDA, have been uniformly criticized for muddled messaging and guidance to the public on masks, vaccines, rapid tests, and other matters; those arguments need no rehashing here. Less well understood is that other sectors of our public-health system—including local agencies and prominent public-health academics—were unprepared for a nationwide infectious-disease emergency, particularly in a divided country with tight limits on government power.

As federal, state, and local health officials struggled in spring 2020 to obtain the basic funding, staff, lab supplies, and data systems to test, trace, and isolate cases, academics on Twitter and cable news became the face of public health—and they zeroed in on the many ways in which the U.S. response to COVID-19 fell short of a textbook approach to pandemic control. Public-health agencies were ill-prepared for this crisis, and academics were ill-prepared to speak on their behalf.

The U.S. has a highly decentralized public-health system that relies on thousands of state and local health agencies operating with a wide degree of independence. The origin of these agencies lies in combatting malaria, yellow fever, smallpox, syphilis, and other infectious diseases; their standard activities historically included controlling mosquitoes, improving water quality and sanitation, isolating and quarantining people during disease outbreaks, and the direct provision of prevention and treatment services.

By the mid-20th century, though, heart disease, lung disease, cancer, and other chronic conditions replaced infectious diseases as the leading causes of death. Over several decades, public-health agencies reduced their focus on environmental dangers, infectious disease, and clinical services. In the 2000s, these agencies dedicated more and more personnel and public communications to tobacco control, promoting physical activity and healthy diets, and screening for diabetes, heart disease, and cancer. The consensus of government and academic public-health experts was that the most effective way for these agencies to serve the public was to reduce illness and death from chronic disease. The key metric for judging the effectiveness of public-health agencies was life expectancy in the community they served, and—at least in the immediate pre-COVID era—promoting healthy lifestyles for all was more likely to avert premature deaths than infectious-disease control was.

In theory, public-health agencies could add chronic-disease control activities without sacrificing their infectious-disease expertise. In reality, however, public-health departments have experienced a progressive decline in real spending power, particularly since the Great Recession, and as a result, have chosen to cut infectious-disease programs. More than 75 percent of the nation’s larger health departments reported eliminating clinical services from 1997 to 2008.

I experienced this shift firsthand. When I began overseeing infectious diseases at New York City’s health department in 2011, I worked for one of the nation’s leading proponents of chronic-disease control: Mayor Michael Bloomberg. Because of budget cuts, we had to shrink our infectious-diseases programs; I had to close or reduce hours for our immunization, sexually-transmitted disease, and tuberculosis clinics. I had to justify these decisions to appropriately disgruntled community groups and city council members by saying that the Affordable Care Act’s Medicaid expansion would pay to ensure that these services could be provided by the private sector—a claim that I based more on hope than evidence.

As local health agencies nationwide scaled back their clinics, they also lost their presence in the community. Clinics are an important way of building visibility and credibility, because most people do not understand what a public-health agency is or does. Residents see the good work you do, tell elected officials that your work matters, and then trust you during emergencies. Running clinics also builds logistical expertise.

Unfortunately, when health agencies were called on to run the largest, most rapid vaccination campaign in U.S. history, most lacked personnel qualified to either run these clinics themselves or oversee contractors effectively. This resulted in debacles like the one in Philadelphia, where the health department let an untested start-up take on the job of running mass-vaccination clinics in the city. Public-health agencies lost an opportunity: One way to overcome vaccine hesitancy is to have trusted providers deliver information and services. Without a strong public presence directly administering vaccines before the pandemic, local health departments were additionally unprepared to reach communities inherently distrustful of a mass-vaccination campaign.

The U.S. is not as different from the rest of the world as Americans frequently think. After the 2002–04 SARS epidemic and the 2014–16 Ebola epidemic in West Africa, independent reviewers of the World Health Organization concluded that the agency had become too focused on providing high-level technical guidance and had failed to invest in staff and systems to respond quickly during emergencies. During the COVID-19 crisis, the agency has been far more effective than during past crises in mobilizing personnel and supplies in all regions of the world for border screening, laboratory testing, and vaccination. The crucial lesson that WHO learned from the earlier epidemics is that failure to rapidly and effectively solve urgent problems, such as infectious-disease outbreaks, destroys your credibility and prevents you from addressing the long-term problems and leading causes of death. Imagine a fire department that was focused on reducing the frequency of kitchen burns and not on putting out infernos in high-rise buildings. That’s the situation that local public-health officials found themselves in.

For most americans, the face of public health during COVID-19 was not, however, local health officials. The most prominent voices—other than Anthony Fauci’s—were university professors proffering guidance on television, in print, and through social media. People who practice public health in government are expected to stick to the talking points for their agency; the mayor or governor whom they serve constrains them from freely explaining their recommendations and decisions. Even if afforded freedom to talk more openly, they lacked the time to do so.

Into that void stepped university-based physicians, epidemiologists, and virologists opining about what the government should do without fully understanding or communicating what was feasible, affordable, legal, and politically acceptable for public-health agencies. When I was advising New York City Mayor Bill de Blasio on how to respond to COVID in 2020 and 2021, the city faced terrible choices. As we attempted to return the country’s largest school district to in-person instruction in the fall of 2020 and then to keep classrooms open in the following months, I had to parse uncertain science while balancing the demands of staff unions, parents, and elected officials. Meanwhile, experts publicly faulted us for our limited ability to identify the source of infection for any given COVID case and for our failure to test every COVID-exposed student every day. Anyone who had actually implemented a large testing-and-contact-tracing program understood the impossibility of such demands. But most of the people with genuine technical expertise were busy practicing public health, not doing multiple cable-news hits a day.

Consumers of that commentary could easily conclude that the government was simply not trying hard enough to stop the virus. And yet state and local health agencies generally cannot remove the major legal, financial, and political constraints they face. For example, critics faulted the CDC and local health agencies for not releasing enough data, but didn’t acknowledge the strict, complex patchwork of regulations at the federal and state level that limit what data public-health agencies can legally receive and report.

Every public-health practitioner I know understands that the U.S. can reduce its vulnerability to epidemics by improving data collection. Likewise, most of my colleagues believe that strengthening the social safety net—particularly through universal health care, paid sick leave, housing, and child care—will improve Americans’ ability to fend off COVID-19 and other threats. But enacting those measures is beyond the power of public-health officials, whose job it is to mitigate harm under real-world conditions. Those conditions include the underlying laws and systems that elected officials created.

Universities and government agencies are subject to different prerogatives. The economic model of public-health schools rewards professors who bring in research grants; tenure committees and research funders do not necessarily demand that professors have experience inside government public-health agencies. In reporting the comments of academic experts, news outlets routinely include their university affiliation. But other credentials are more crucial: Have you ever run a large government health program? Have you ever led an official outbreak investigation? Academic experts can offer the public an idealized version of what public health could be, but during this pandemic they have also played a role in setting unrealistic expectations—for instance, that emergency measures could go on indefinitely, until society’s underlying failures are addressed.

I don’t mean to be too critical of my academic colleagues. (Full disclosure: I now teach at a university too.) The greatest threats to public health right now come from elected officials who would gut public-health agencies’ budgets and legal authority on the grounds that they threaten individual liberties.

One way to avoid that fate is for health leaders to recognize that their daily work is largely invisible to the general public—and that the public expects health agencies to focus on threats that they do not believe they can protect themselves from. Public-health experts, both in academia and in government, rightly point out that the holes in social-welfare policies are the primary determinants of ill health. These experts also believe that, for instance, promoting healthy diets and encouraging people to wear masks are worthy goals of government policy. But most Americans, for better or worse, still prioritize individual choice more and community protection less than those of us drawn to the public-health field do.

To rally voters’ support, agencies need to make themselves more visible in public life through direct clinical services and ensure that they are dedicating sufficient resources, even within constrained budgets, to public-health-emergency response. Meanwhile, the interested voter should press elected officials on their plans for restoring infectious-disease and emergency-response services. Ultimately, the highest aspirations of the public-health profession must coexist with the reality of law and where power actually resides in a democracy: with voters and their elected representatives.

Jay Varma, a professor at Weill Cornell Medical School, is a physician and epidemiologist who worked for the CDC in New York, Bangkok, Beijing, and Addis Ababa.

 

How America Reached One Million Covid Deaths

THE MAGNITUDE OF THE country's loss is nearly impossible to grasp.

More Americans have died of Covid-19 than in two decades of car crashes or on battlefields in all of the country's wars combined.

Experts say deaths were all but inevitable from a new virus of such severity and transmissibility. Yet, one million dead is a stunning toll, even for a country the size of the United States, and the true number is almost certainly higher because of undercounting.

It is the result of many factors, including elected officials who played down the threat posed by the coronavirus and resisted safety measures; a decentralized, overburdened health care system that struggled with testing, tracing and treatment; and lower vaccination and booster rates than other rich countries, partly the result of widespread mistrust and resistance fanned by right-wing media and politicians.

The virus did not claim lives evenly, or randomly. The New York Times analyzed 25 months of data on deaths during the pandemic and found that some demographic groups, occupations and communities were far more vulnerable than others. A significant proportion of the nation's oldest residents died, making up about three-quarters of the total deaths. And among younger adults across the nation, Black and Hispanic people died at much higher rates than white people.

Understanding the toll — who makes up the one million and how the country failed them — is essential as the pandemic continues. More than 300 people are still dying of Covid every day.

"We are a country with the best doctors in the world, we got a vaccine in an astoundingly short period of time, and yet we've had so many deaths," said Mary T. Bassett, the health commissioner for New York State.

"It really should be a moment for us all to reflect on what sort of society we want to have..."

https://www.nytimes.com/interactive/2022/05/13/us/covid-deaths-us-one-million.html

Can Anyone Out-Plan a Pandemic?

Bill Gates has a strategy to save the world from the next infectious threat. He’s not the first.

...To believe that you need only a plan rests on an assumption that humans are rational creatures who have roughly the same values and priorities as you do, and—even more improbable—that humans are inclined to follow plans of any kind. After all, when Gates laid out a strategy for solving climate change last year, he was boldly going where world leaders had gone many, many times before without success. The United Nations has held no fewer than 26 annual climate-change conferences. The world committed to the Kyoto Protocol in 1997, but failed to meet its goals. The Paris Agreement is seven years old, and the UN itself says we’re falling short. But Gates told me that the plan he offered in How to Avoid a Climate Disaster has already done some good for the planet...
https://www.theatlantic.com/science/archive/2022/05/bill-gatess-plan-save-world-next-pandemic/629826/?utm_source=email&utm_medium=social&utm_campaign=share

Our Obsession with Ancestry Has Some Twisted Roots

...Today’s addictive Web sites and sleekly packaged DNA kits rest on deep, if not always acknowledged, assumptions about the fixity of status, race, ethnicity, and nationality... NYer

Something in the Way We Move

We may each have a movement "signature" that, like our face or fingerprints, is unique to us.

Each of us appears to have a unique way of moving, a physical "signature" that is ours alone, like our face or fingerprints, according to a remarkable new study of people and their muscles. The study, which used machine learning to find one-of-a-kind patterns in people's muscular contractions, could have implications for our understanding of health, physical performance, personalized medicine and whether and why people can respond so differently to the same exercise.

Intuitively, most of us probably know there is something in the way we move, and that that something defines us. In studies and daily life, most people can pick out their friends and loved ones, based solely on how they walk. At least one surveillance company also claims to be able to identify and track people using their gaits... nyt

 Joke:

The student asked the professor how many problems there would be on the final exam.

The professor looked the student over and replied, "I think you will have lots of problems on the final."

Racial disparities in US healthcare

	CBS Sunday Morning 🌞 ⁦‪@CBSSunday‬⁩ Oprah Winfrey's Smithsonian Channel documentary, "The Color of Care," examines how COVID has exposed the prevalence of racial disparities in our healthcare system, costing lives cbsn.ws/3Ly7upn pic.twitter.com/Pd0EwBeNP9   5/1/22, 9:20 AM

FINAL POST: The Ethics of Harm Reduction

Hi everyone! Today we will be speaking about harm reduction.

Harm reduction offers a “pragmatic yet compassionate set of strategies designed to reduce the harmful consequences of addictive behavior for both drug consumers and the communities in which they live.” (Marlatt)

So what are some examples of harm reduction you can think of?

One example that I think of is having a designated driver when a group of people attend a party where there will be alcohol. Another one I can think of is teaching children about condom use during sex education. Even seatbelts are an example of harm reduction!

While harm reduction is a rather broad topic and can relate to many different areas, I will be focusing on harm reduction as it relates to substance use, with a specific focus on opioid drug use.

So, we’re talking about reducing potential harms, but what exactly are these harms associated with drug use? Keep in mind that these harms affect not only the individual but society as well. We can divide them up into direct and indirect harms. Direct harms are more what affects strictly that person’s health while indirect harms have more to do with society and situation.

Direct 

-substance use disorder

-bloodborne illnesses (HIV, hepatitis C)

-injection-related bacterial infections (local and systemic)

-overdose complications, including death

Indirect

-violence, homicide, property crime

-involvement in the sex trade

-public stigmatization (It is important to avoid using older, stigmatizing terms when discussing this topic: https://www.bmc.org/addiction/reducing-stigma)

-homelessness

-incarceration

While attempting to stop illegal drug use, current policies have also contributed to poverty, mass incarceration, and racial disparities. (Vearrier) Harm reduction is designed to decrease HIV transmission and overdose risk while keeping in mind these consequences.

Now, I will be talking about three types of harm reduction used in the U.S. for injection drug use. The first is OEND, or Opioid Overdose Education and Naloxone Distribution. Naloxone is a narcotic that is an antidote for opioid overdose. It is an opioid antagonist, which means that it binds to the sites that opioids usually bind to. Thus, it can reverse or block any effects of other opioids. The point of this harm reduction strategy is to educate people about overdose prevention, what overdose looks like, and what to do in the case of an overdose.




(https://www.co.marion.or.us/HLT/MH/Pages/Narcan-Distribution-Program.aspx)

Next, I’ll talk about the needle and syringe exchange program which many of you have probably heard of before. This program designates sites to collect syringes and dispose of them safely, which is important because diseases such as HIV/AIDS, hepatitis B, and hepatitis C can be spread through this mode. They also provide sterile syringes and other supplies to people. There are 11 official sites in Tennessee and 2 unofficial sites. (Tennessee Harm Reduction)

(https://en.wikipedia.org/wiki/Needle_and_syringe_programmes)

Now, we'll take a look at opioid maintenance therapy, which is where relatively safer opioids are given to patients who struggle with an opioid use disorder. Methadone and suboxone are longer-acting opiates that are taken orally (safer!). However, a patient can get dependent on both of these, and they do have some street value. There are many regulations in place for these medications to be dispensed. For example, methadone can only be dispensed from specialized clinics, and at the beginning of treatment, patients are actually required to swallow the pills while in the clinic and submit to random urine drug screens and pill counts.




(https://www.northpointrecovery.com/blog/opioid-replacement-therapy-risks-methadone-vs-buprenorphine/)

So now that we’ve talked about these strategies, let’s examine them using the four guiding principles of ethics.

-Autonomy: Yes, we are meeting patients where they are. ("come as you are, and I’ll treat you” & “whether you are using or not, I’ll help you”)
-Beneficence: Yes. This will decrease HIV and overdose risk, doctors get informed consent from patients before prescribing anything, and it decreases the indirect harms associated with drug use.
-Non-maleficence: We could essentially cause harm--a patient could previously be addicted to heroin and now be addicted to or even overdose on methadone. However, we use the equation "total harm = average harm per use x total use" to understand the amount of harm involved. A doctor may have hurt or even led to someone's death with the prescription, but if we look at all the people who have used these opiates and survived many uses because of the prescription, it is good overall.
-Justice: Yes. These harm reduction strategies play a part in eliminating racial disparities and decreasing the amount of people who are incarcerated and houseless.

Now, let’s take this a step further. Let’s talk about two other harm-reduction strategies that are not yet accepted and widely used in the United States. The first is safe injection sites. Basically, safe injection sites provide someone who uses drugs a safe place to come in and use, and there are trained staff present to keep an eye on them. And if they observe signs of overdose, the staff has naloxone on hand and can call for medical help. There are a few of these sites in New York. Per the federal government, the possession of these drugs are illegal, so the sites make a pact with the local law enforcement and agree that these patients will not be prosecuted for possession.




(https://capitalandmain.com/moving-the-needle-science-supports-supervised-injection-sites-why-dont-politicians-agree-1024)

Next, for patients who continue to use heroin despite being prescribed suboxone and methadone, medical-grade heroin can dispensed. There is one site in Canada that does this. What do you guys think about this?

So while the ultimate goal is abstinence, when patients are not able to abstain or are not willing to abstain, rather than ignoring their needs or using punitive measures, harm reduction allows us to meet them where they are and offer some strategies to decrease harm not only to them but also to society.

Some important things to keep in mind are:

1. Getting informed consent

2. Clearly defining the parameters within which these harm reduction strategies will be implemented to minimize risk (train doctors, understand how these treatments work, minimize risk of diversion, minimize risk of overdose)

3. For optimal effects, there may need to be changes to our laws and public opinion so they can go hand-in-hand with the harm reduction strategies we want to implement.

Sources:

Hedrich D, Alves P, Farrell M, Stöver H, Møller L, Mayet S. The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Addiction. 2012 Mar;107(3):501-17. doi: 10.1111/j.1360-0443.2011.03676.x. PMID: 21955033.

Khalid, Farhan et al. “Social Stigmatization of Drug Abusers in a Developing Country: A Cross-Sectional Study.” Cureus vol. 12,9 e10661. 26 Sep. 2020, doi:10.7759/cureus.10661

Marlatt, G.Alan. “Harm Reduction: Come as You Are.” Addictive Behaviors, vol. 21, no. 6, 1996, pp. 779–788., https://doi.org/10.1016/0306-4603(96)00042-1.

Stoljar N. Disgust or Dignity? The Moral Basis of Harm Reduction. Health Care Anal. 2020 Dec;28(4):343-351. doi: 10.1007/s10728-020-00412-y. Epub 2020 Oct 24. PMID: 33098488.

Vearrier L. The value of harm reduction for injection drug use: A clinical and public health ethics analysis. Dis Mon. 2019 May;65(5):119-141. doi: 10.1016/j.disamonth.2018.12.002. Epub 2018 Dec 29. PMID: 30600096.